WO2015157676A1 - Instruments chirurgicaux marqués et procédés associés - Google Patents

Instruments chirurgicaux marqués et procédés associés Download PDF

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Publication number
WO2015157676A1
WO2015157676A1 PCT/US2015/025376 US2015025376W WO2015157676A1 WO 2015157676 A1 WO2015157676 A1 WO 2015157676A1 US 2015025376 W US2015025376 W US 2015025376W WO 2015157676 A1 WO2015157676 A1 WO 2015157676A1
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WO
WIPO (PCT)
Prior art keywords
tag
imaging
sphere
surgical instrument
bead
Prior art date
Application number
PCT/US2015/025376
Other languages
English (en)
Inventor
William A. Blair
Original Assignee
Rf Surgical Systems, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Rf Surgical Systems, Inc. filed Critical Rf Surgical Systems, Inc.
Priority to CN201580016060.5A priority Critical patent/CN106604751A/zh
Priority to EP15776698.1A priority patent/EP3129077A4/fr
Priority to AU2015243218A priority patent/AU2015243218B2/en
Priority to US15/303,286 priority patent/US20170027660A1/en
Publication of WO2015157676A1 publication Critical patent/WO2015157676A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L17/00—Materials for surgical sutures or for ligaturing blood vessels ; Materials for prostheses or catheters
    • A61L17/04—Non-resorbable materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/481—Diagnostic techniques involving the use of contrast agent, e.g. microbubbles introduced into the bloodstream
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/90—Identification means for patients or instruments, e.g. tags
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L17/00—Materials for surgical sutures or for ligaturing blood vessels ; Materials for prostheses or catheters
    • A61L17/14—Post-treatment to improve physical properties
    • C—CHEMISTRY; METALLURGY
    • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
    • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
    • C08L25/00—Compositions of, homopolymers or copolymers of compounds having one or more unsaturated aliphatic radicals, each having only one carbon-to-carbon double bond, and at least one being terminated by an aromatic carbocyclic ring; Compositions of derivatives of such polymers
    • C08L25/02—Homopolymers or copolymers of hydrocarbons
    • C08L25/04—Homopolymers or copolymers of styrene
    • C08L25/06—Polystyrene
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00526—Methods of manufacturing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A61B2090/3929—Active markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3933—Liquid markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/10—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing inorganic materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/44—Radioisotopes, radionuclides

Definitions

  • a tag comprising an imaging sphere suspended within a matrix.
  • the matrix comprises a polymer.
  • the polymer may comprise an adhesive polymer.
  • the polymer may comprises cyanoacrylate.
  • the polymer comprises a shelf-stable polymer.
  • the matrix comprises an epoxy.
  • the imaging sphere comprises a cavity loaded with an imaging agent surrounded by a shell.
  • the imaging agent exhibits echogenic properties.
  • the imaging agent is a gas.
  • the gas is dissolved in a solution.
  • the gas resonates when impinged upon by ultrasound.
  • the gas emits ultrasound at harmonic frequencies.
  • the shell comprises an inorganic material.
  • the inorganic material comprises silica or titanium.
  • a tagged surgical instrument comprising a surgical instrument and the tag described herein.
  • the instrument is a needle.
  • the tag is embedded in a thread filament.
  • the tag attaches a thread filament to the needle.
  • a method for preparing an imaging sphere comprising: depositing organic or inorganic material onto a bead surface to form a sphere with a solid core; removing the solid core by solvent extraction or calcination to form a hollow sphere; and loading the hollow sphere with an imaging agent.
  • the inorganic material is silica or titanium.
  • the bead is a polymeric bead.
  • the polymeric bead comprises amine-functionalized polystyrene.
  • the polymeric bead comprises one or more of the following polymers: opolyacrylamine, poly (vinyl chloride), poly (vinyl chloride) carboxylated, polystyrene, polypropylene, or poly (vinyl chloride-co-vinyl acetate co- vinyl) alcohols.
  • the bead has a diameter between about 40 nm to about 500 micron.
  • the bead has a diameter between about 400 nm to about 100 micron. In some embodiments, the bead has a diameter between about 500 nm to about 10 micron. In some embodiments, the bead has a diameter greater than 500 nm.
  • the organic or inorganic material further comprises a dopant. In some embodiments, the dopant is Iron(III) Oxide or Boron.
  • the method further comprises subjecting the hollow sphere to a vacuum prior to loading the hollow sphere with an imaging agent. In some embodiments, the imaging agent exhibits echogenic properties. In some embodiments, the imaging agent is a gas. In some embodiments, the gas is dissolved in a solution.
  • the gas resonates when impinged upon by ultrasound. In some embodiments, the gas emits ultrasound at harmonic frequencies.
  • a method for tagging a surgical instrument comprising applying a tag, wherein the tag comprises an imaging sphere suspended within a matrix, to the instrument as a coating on a portion of the surgical instrument. In some embodiments, the tag comprises an adhesive polymer.
  • a method for tagging a surgical instrument comprising applying a tag, wherein the tag comprises an imaging sphere suspended within a matrix, to a portion of a surface of the instrument. In some embodiments, the tag is applied to the surface as a dot or stripe.
  • a tag comprising an imaging sphere suspended within a matrix.
  • the matrix comprises a polymer.
  • the matrix comprises an adhesive polymer.
  • the matrix comprises a shelf-stable polymer.
  • the matrix comprises an epoxy.
  • the adhesive polymer comprises cyanoacrylate.
  • the imaging sphere comprises a cavity loaded with an imaging agent surrounded by a shell.
  • the imaging agent exhibits echogenic properties.
  • the imaging agent is a gas.
  • the gas is dissolved in a solution.
  • the gas resonates when impinged upon by ultrasound.
  • the gas emits ultrasound at harmonic frequencies.
  • the shell comprises an inorganic material.
  • the inorganic material is silica or titanium.
  • a tagged surgical instrument comprising a surgical instrument and a tag.
  • the instrument is a needle.
  • the tag is embedded in a thread filament.
  • the tag attaches a thread filament to the needle.
  • a method for preparing an imaging sphere comprising: (i) depositing organic or inorganic material onto a bead surface to form a sphere with a solid core; (ii) removing the solid core by solvent extraction or calcination to form a hollow sphere; and (iii) loading the hollow sphere with an imaging agent.
  • the inorganic material is silica or titanium.
  • the bead is a polymeric bead.
  • the polymeric bead comprises amine- functionalized polystyrene.
  • the polymeric bead comprises one or more of the following polymers: opolyacrylamine, poly (vinyl chloride), poly (vinyl chloride) carboxylated, polystyrene, polypropylene, or poly (vinyl chloride-co-vinyl acetate co-vinyl) alcohols.
  • the bead has a diameter between about 40 nm to about 500 micron. In some embodiments, the bead has a diameter between about 400 nm to about 100 micron. In some embodiments, the bead has a diameter between about 500 nm to about 10 micron. In some embodiments, the bead has a diameter greater than 500 nm.
  • the organic or inorganic material further comprises a dopant. In some
  • the dopant is Iron (III) Oxide or Boron.
  • the hollow sphere is subjected to a vacuum prior to loading the hollow sphere with an imaging agent.
  • the imaging agent exhibits echogenic properties.
  • the imaging agent is a gas.
  • the gas is dissolved in a solution.
  • the gas resonates when impinged upon by ultrasound.
  • the gas emits ultrasound at harmonic frequencies.
  • a method for tagging a surgical instrument comprising applying a tag to the instrument as a coating on a portion of the surgical instrument.
  • the tag comprises an adhesive polymer.
  • a method for tagging a surgical instrument comprising applying a tag to a portion of a surface of the instrument.
  • the tag is applied to the surface as a dot or stripe.
  • Figure 1A depicts an embodiment including a surgical instrument comprising a surgical needle, a surgical thread, and a tag comprising an imaging sphere suspended in an adhesive polymer placed at the joint area of the surgical needle and surgical thread.
  • Figure IB depicts a magnified view of the joint area of the surgical instrument embodiment of Figure 1A.
  • a tag comprising an imaging sphere suspended within a matrix.
  • a method for preparing an imaging sphere comprising: depositing organic or inorganic material onto a bead surface to form a sphere with a solid core; removing the solid core by solvent extraction or calcination to form a hollow sphere; and loading the hollow sphere with an imaging agent.
  • a method for tagging a surgical instrument comprising applying a tag, wherein the tag comprises an imaging sphere suspended within a matrix, to the instrument as a coating on a portion of the surgical instrument.
  • a method for tagging a surgical instrument comprising applying a tag, wherein the tag comprises an imaging sphere suspended within a matrix, to a portion of a surface of the instrument.
  • kits for treating instruments relate to the detection of instruments before, during or after surgery.
  • the methods, compositions, materials, tags, and surgical instruments relate to providing an image or signal detecting instruments that are removed from or that have not been removed from a subject undergoing surgery.
  • an imaging technique for non-limiting example, an imaging technique such as ultrasound.
  • a detectable tag is present on or in the instrument.
  • a detectable tag is incorporated into the surgical instrument, for non-limiting example, in polymer thread filaments for a needle.
  • tagged surgical instruments are disposable.
  • a needle incorporates a tag into the joint area, for non-limiting example, the joint area between the metal head and the sewing thread.
  • a surgical instrument is coated with a tag.
  • a surgical instrument is tagged with a discrete dot or stamp that is detectable by an imaging technique or an imaging device while the surgical instrument is within the body of a subject. Thus, the tag is detectable at body temperature.
  • the tags comprise compositions of imaging spheres suspended in a polymer matrix.
  • the sphere comprises a shell that is detectable by an imaging technique or an imaging device.
  • the sphere comprises a core that is detectable by an imaging technique or an imaging device.
  • the sphere comprises a shell having a core comprising an imaging agent, for non-limiting example, a gas, that is detectable by an imaging technique or an imaging device.
  • imaging spheres are suspended or embedded in a matrix, for non-limiting example, polymer matrix or epoxy.
  • an imaging agent is attached to the inner or outer surface of a sphere's shell.
  • tagged surgical instruments that are suitable for storage conditions.
  • tagged surgical instruments are stable to heat, humidity or both.
  • tagged surgical instruments exhibit shelf- stability over various lengths of time.
  • materials, compositions, and tags are suitable for storage conditions.
  • materials, compositions, and tags are stable to heat, humidity or both.
  • materials, compositions, and tags exhibit shelf-stability over various lengths of time.
  • methods are provided for increasing shelf-stability of a tagged surgical instrument, composition, tag, or material.
  • methods for increasing shelf-stability comprise doping a sphere's shell, wherein the sphere or a plurality of the spheres is incorporated into a tag, such as into a coating on a surgical instrument and wherein the sphere comprises a core that is detectable by an imaging technique or by an imaging device.
  • dopant refers to a charge-transfer agent used to generate, by oxidation or reduction, positive or negative charges in an intrinsically conducting polymer.
  • dopants include AsFs or I 2 as oxidizing agents, generating cation radicals on the chains of an intrinsically conducting polymer (so-called holes), or a solution of sodium naphthalenuidyl in tetrahydrofuran as a reducing agent, generating anion radicals on the chains of an intrinsically conducting polymer.
  • emulsion polymerization refers to a polymerization process whereby monomer(s), initiator, dispersion medium, and possibly colloid stabilizer initially an in homogeneous system resulting in particles of colloidal dimensions containing the formed polymer.
  • force refers to a surgical instruments used to grasp, hold or occlude.
  • Examples include, but are not limited to, hemostats, dressing and tissue forceps, bone holding forceps, and needle holders.
  • imaging agent refers to a chemical substance that is capable of detection with the aid of a medical imaging device, including but not limited to, fluoroscopy, magnetic resonance imaging (MRI), ultrasound, X-ray, positron emission tomography (PET), SPECT tomography, and any compatible tomography imaging.
  • nanosphere refers to a sphere in the nanometer size range that ranges from about 40 nanometers in diameter to about 500 nanometers in diameter, at most about 500 nanometers in diameter, from 40 nanometers in diameter to 500 nanometers in diameter, or at most 500 nanometers in diameter.
  • a nanosphere need not be perfectly spherical in shape, and may have an average diameter as noted herein, that is, the average diameter may be from about 40 nanometers to about 500 nanometers, at most about 500 nanometers, from 40 nanometers to 500 nanometers, or at most 500 nanometers, while other diameters of the nanosphere may be larger or smaller than this average.
  • a plurality of nanospheres used in the tags disclosed herein may not be perfectly uniform in diameter, and may include a range of average diameters, so long as the overall average diameter of the plurality of nanospheres ranges from about 40 nanometers to about 500 nanometers, at most about 500 nanometers, from 40 nanometers to 500 nanometers, or at most 500 nanometers.
  • a nanosphere includes an imaging agent, it is referred to as an "imaging nanosphere” herein, and is configured to be capable of being imaged in a subject during surgery or after a surgery by an imaging technique or by an imaging device as noted herein.
  • sphere refers to a sphere that ranges from about 40 nanometers in diameter to about 0.5 millimeters in diameter, at most about 0.5 millimeters in diameter, from 40
  • a sphere comprises a diameter ranging in size from about 40 nanometers to about 500 micrometers (micron); from about 40 nanometers to about 300 micron; from about 100 nanometers to about 100 micron; from about 200 nanometers to about 1 micron; from about 200 nanometers to about 700 nanometers; or from about 400 nanometers to about 500 nanometers.
  • a sphere need not be perfectly spherical in shape, and may have an average diameter as noted herein, that is, the average diameter may be from about 40 nanometers to about 0.5 millimeters, at most about 0.5 millimeters, from 40 nanometers to 0.5 millimeters, at most 0.5 millimeters, from about 40 nanometers to about 0.1 millimeters, at most about 0.1 millimeters, from 40 nanometers to 0.1 millimeters, at most 0.1 millimeters, about 40 nanometers to about 500 micrometers (micron), from about 40 nanometers to about 300 micron, from about 100 nanometers to about 100 micron, from about 200 nanometers to about 1 micron, from about 200 nanometers to about 700 nanometers, or from about 400 nanometers to about 500 nanometers, while other diameters of the sphere may be larger or smaller than this average.
  • a plurality of spheres used in the tags disclosed herein may not be perfectly uniform in diameter, and may include a range of average diameters, so long as the overall average diameter of the plurality of spheres ranges from about 40 nanometers to about 0.5 millimeters, at most about 0.5 millimeters, from 40 nanometers to 0.5 millimeters, at most 0.5 millimeters, from about 40 nanometers to about 0.1 millimeters, at most about 0.1 millimeters, from 40 nanometers to 0.1 millimeters, at most 0.1 millimeters, about 40 nanometers to about 500 micrometers (micron), from about 40 nanometers to about 300 micron, from about 100 nanometers to about 100 micron, from about 200 nanometers to about 1 micron, from about 200 nanometers to about 700 nanometers, or from about 400 nanometers to about 500 nanometers.
  • spheres As used herein with respect to the size of spheres, the term “about” means ranges of 1%, 5%, 10%, or 25% of the diameter.
  • imaging sphere When a sphere includes an imaging agent, it is referred to as an "imaging sphere” herein, and is configured to be capable of being imaged in a subject during surgery or after a surgery by an imaging technique or by an imaging device as noted herein. Any of the spheres or imaging spheres described herein may be of the nano-size, without referring to them specifically as nanospheres or imaging nanospheres specifically. Thus, spheres may include nanospheres and/or larger-than-nano sized spheres; and imaging spheres may include imaging nanospheres and/or larger-than-nano sized imaging spheres.
  • polymer bead refers to a sphere of polymer, e.g., polystyrene beads.
  • polymer emulsion refers to an emulsion in which the dispersed phase is a liquid polymer or a polymer solution.
  • porosity refers to the pore space in a material.
  • the term "retractor” refers to a surgical instrument used to retract. Examples include, but are not limited to, hand-held and self-retaining retractors, as well as instruments such as skin and bone hooks.
  • shharp refers to a surgical instrument used to cut or incise. Examples include, but are not limited to, scissors, knives, scalpels, chisels and osteotomes, among others.
  • support medium refers to a lubricant or glue. Examples include, but are not limited to, silicone, rtp, cyanoacrylate and acrylic, among others.
  • instruments or “surgical instruments” or “surgical instrument devices” or “surgical devices” refer to the singular or plural version of any one or more of the following example surgical instruments: articulator, bone chisel, cottle cartilage crusher, bone cutter, bone distractor, Ilizarov apparatus, intramedullary kinetic bone distractor, bone drill, bone lever, bone mallet, bone rasp, bone saw, bone skid, bone splint, caliper, cannula, cautery, curette, depressor, dilator, dissecting knife, surgical Pinzette, dermatome, forceps such as bone forceps, carmalt forceps, crushing forceps, dandy forceps Debakey forceps, dissecting forceps, Doyen intestinal clamp, epilation forceps, Halstead forceps, Kelly forceps, Kocher forceps, mosquito forceps, tissue forceps, sponge forceps, Backhaus towel forceps, Lorna towel forceps, or towel forcep
  • Richardson-Eastmann retractor Kelly retractor, Parker retractor, Parker-Mott retractor, Roux retractor, Mayo-Collins retractor, ribbon retractor, Aim retractor, self -retaining retractors, Beckman- Weitlaner retractor, Beckman-Eaton retractor, Beckman retractor, or Adson retractor, rib spreader, rongeur, ultrasonic scalpel, laser scalpel, scissors, iris scissors, Kiene scissors, Metzenbaum scissors, Mayo scissors, Tenotomy scissors, spatula, speculum, mouth speculum, rectal speculum, Sim's vaginal speculum, Cusco's vaginal speculum, sponge bowl, sterilization tray, sterna saw, suction tube, surgical elevator, surgical hook, surgical knife, surgical mesh, surgical needle, surgical snare, surgical sponge, surgical spoon, surgical stapler, surgical tray, suture, tongue depressor, tonsillotome, towel clamp, tracheotome, tissue expander
  • instruments or “surgical instruments” or “surgical instrument devices” or “surgical devices” may refer to the singular or plural version of any surgical instruments or tool or accessory not mentioned in the listing above which may be adapted with coatings or other preparations noted herein in order to visualize such instrument, accessory or tool before, during, or following a surgical procedure.
  • a surgical instrument is detected in an individual or a subject during surgery with the aid of an imaging technique. Detection of a surgical instrument is achieved via imaging of a tag on or in the surgical instrument, or via imaging a tag that is used in conjunction with the surgical instrument. In some embodiments, a surgical instrument is detected in a subject during surgery in real-time (i.e. during the surgical procedure) using an imaging device that detects the tag. In some embodiments, a surgical instrument is detected in a subject after surgery or after a surgical procedure using an imaging device that detects the tag.
  • Tags Comprising Imaging Spheres and Use with Imaging Techniques
  • a tag for use with an imaging technique or an imaging device to detect a surgical instrument, wherein the tag comprises an imaging agent.
  • a tag comprises a matrix and an imaging sphere. In some embodiments, a tag comprises a matrix, imaging sphere, and support medium. In some embodiments, a tag comprises an imaging sphere suspended in a matrix. In some embodiments, a tag comprises an imaging sphere dispersed within a matrix. In some embodiments, a tag comprises an imaging sphere suspended in a matrix and adsorbed to a support medium.
  • a matrix comprises any suitable polymer.
  • the matrix comprises an adhesive polymer.
  • the matrix comprises a shelf- stable polymer.
  • the matrix comprises a polymer that is stable to sterilization conditions.
  • the matrix comprises a polymer that is stable in water, at high temperature, or both.
  • the matrix comprises an epoxy. In some embodiments, the matrix comprises a heat-resistant epoxy. In some embodiments, the matrix comprises a water-resistant epoxy. In some embodiments, the matrix comprises a glue, for non-limiting example, cyanoacrylate or acrylic glue. In some embodiments, the matrix comprises an adhesive polymer.
  • the imaging sphere comprises a diameter anywhere from the nanometer range to micrometer range or to the sub-millimeter range. In some embodiments, the imaging sphere is visible to the naked eye. In some embodiments, an imaging sphere comprises a diameter ranging in size from about 40 nanometers to about 500 micrometers (micron); from about 40 nanometers to about 300 micron; from about 100 nanometers to about 100 micron; from about 200 nanometers to about 1 micron; from about 200 nanometers to about 700 nanometers; or from about 400 nanometers to about 500 nanometers.
  • the imaging sphere is suspended in a matrix in clusters.
  • multiplied effects are displayed in clusters inside the glue.
  • the imaging sphere comprises a hollow cavity and a shell. In some embodiments, subsequent to forming the hollow cavity, such cavity is loaded with an imaging agent (and thereafter is no longer hollow).
  • the shell comprises inorganic materials (hard shell). In some embodiments, the shell comprises organic materials (soft shell) such as proteins (for non-limiting example, albumin), lipids, or polysaccharides.
  • a hard shell comprises a polymer, for non-limiting example, cyanoacrylate.
  • a hard shell comprises silica or silica derivatives. In some embodiments, a hard shell comprises titanium or titanium derivatives, for non-limiting example, titanium dioxide. In some embodiments, a titanium sphere is prepared using titanium i-butoxide.
  • a physical characteristic of the imaging sphere's shell is adjusted or optimized by adding a dopant.
  • a suitable dopant increases porosity of the sphere's shell.
  • a suitable dopant decreases porosity of the sphere's shell.
  • a suitable dopant increases the strength of the sphere's shell.
  • a suitable dopant decreases the strength of the sphere's shell.
  • a suitable dopant increases the biodegradability of a sphere's shell.
  • a suitable dopant decreases the biodegradability of a sphere's shell.
  • the imaging sphere's shell is doped with Iron Oxide or Boron.
  • porosity of the imaging sphere's shell is varied by adjusting parameters including electrolyte composition, dopant type, dopant concentration, applied voltage, temperature, light intensity, or any combination thereof.
  • the porosity of the imaging sphere's shell is directly proportional to the imaging sphere's biodegradability, i.e., an increase in a shell's porosity leads to an increase in the shell's biodegradability.
  • the porosity of the imaging sphere's shell affects the shelf-life of the imaging sphere.
  • the porosity of the imaging sphere's shell is inversely proportional to the imaging sphere's shelf-life, i.e., a decrease in a shell's porosity leads to an increase in the shell's shelf-life stability.
  • the biodegradability of the imaging sphere's shell is preferably optimized via doping.
  • the shelf-life stability of the imaging sphere's shell is preferably optimized via doping.
  • Smaller spheres have higher surface area to volume ratios than larger spheres. In certain embodiments, it is advantageous to have spheres with a high surface area to volume ratio. In some embodiments, it is advantageous to have spheres with a low surface area to volume ratio.
  • a wide range of surface to volume ratios are contemplated herein depending on the size of the surgical instrument. For example a small surgical instrument, such as a surgical needle, may require smaller spheres, however, may require a higher total number of spheres in the tag itself to be visualized by the imaging technique. In contrast a larger surgical instrument may only require larger spheres and fewer of them in order to be detectable, although smaller spheres may also work in such an embodiment. In either instance, whether for a large surgical instrument or a smaller surgical instrument, however, nanospheres or spheres of larger-than-nano size may be useful and capable of being detected in tags described herein.
  • the hollow cavity of the imaging sphere is loaded (or filled) with an imaging agent.
  • an imaging agent is loaded into the cavity of the imaging sphere.
  • a sphere comprising a shell defining a cavity, and an imaging agent in said cavity.
  • the imaging sphere is a nanosphere that encapsulates an imaging agent.
  • the imaging agent is a gas.
  • the imaging agent is a gel.
  • the imaging agent is a hydrogel.
  • an imaging agent comprises any material that is capable of detection by imaging.
  • an imaging agent is compatible with one or more of the following imaging techniques: fluoroscopy, magnetic resonance imaging (MRI), ultrasound, X- ray, positron emission tomography (PET), or SPECT tomography.
  • imaging techniques fluoroscopy, magnetic resonance imaging (MRI), ultrasound, X- ray, positron emission tomography (PET), or SPECT tomography.
  • MRI magnetic resonance imaging
  • PET positron emission tomography
  • SPECT tomography positron emission tomography
  • the imaging agent is compatible with fluoroscopy.
  • the imaging agent comprises a contrast media, such as barium or iodine.
  • the imaging agent comprises a radio-opaque contrast media, such as barium.
  • the imaging agent comprises a radioactive material such as radioactive isotopes. Radioactive imaging agents are compatible with magnetic resonance imaging.
  • the imaging agent comprises a short-lived isotope.
  • the short-lived isotope facilitates imaging with gamma cameras. Gamma cameras are used in scintigraphy, SPECT and PET.
  • the short-lived isotope comprises Thallium 201TI, Technetium 99mTC, Iodine 1231, or Gallium 67Ga.
  • the imaging agent comprises a short-lived positron emitting isotope, such as 18 F, incorporated into an organic substance.
  • the imaging agent comprises echogenic properties. In some embodiments, the imaging agent is detectable via ultrasound. In some embodiments, the imaging agent is detectable via ultrasonic color Doppler imaging. In some embodiments, the imaging agent comprises air, nitrogen, perfluorocarbon, perflutren, fluorocarbon or
  • the imaging sphere comprises gas that resonates when impinged upon by ultrasound.
  • the shell of the imaging sphere encapsulates a gas that resonates when impinged upon by ultrasound.
  • the imaging sphere is alternatively referred to as a nanobubble.
  • the imaging sphere is a microsphere that encapsulates a gas that resonates when impinged upon by ultrasound, the imaging sphere is alternatively referred to as a microbubble.
  • the imaging agent comprises a gas that resonates when impinged upon by ultrasound and emits ultrasound at harmonic frequencies.
  • the imaging sphere encapsulates a gas that resonates when impinged upon by ultrasound wherein the gas is fully or partially dissolved in another medium, for non-limiting example, liquid.
  • the imaging sphere encapsulates a solution saturated with a gas.
  • the imaging sphere encapsulates a solution saturated with a gas, wherein the solution is shelf-stable.
  • the imaging sphere encapsulates a solution saturated with a gas, wherein the solution is stable to a variety of temperatures.
  • the imaging sphere comprises a gas wherein the imaging sphere is shelf-stable.
  • the imaging sphere comprises a gas wherein the imaging sphere is stable at a variety of temperatures. In some embodiments, the imaging sphere comprises a gas in solution wherein the solution is stable to typical storage conditions, e.g., temperature and length of time.
  • the imaging sphere comprises a quantum dot, e.g., CdSe, CdTe, CdS, ZnSe, PbS, and PbTe.
  • the quantum dot provides a bright fluorescence.
  • the quantum dot possesses photostability.
  • the quantum dot exhibits near-infrared emission.
  • imaging agents comprise magnetic nanoparticles. In some embodiments, imaging agents comprise superparamagnetic properties. In some embodiments, magnetic nanoparticles are used in conjunction with MRI.
  • imaging agents comprise Lanthanide nanoparticles.
  • Lanthanide nanoparticles are detectable via fluorescence imaging.
  • the silica is doped with dye.
  • Dye- doped silica nanoparticles produce a highly amplified optic signal.
  • the dye is trapped inside the silica matrix, which provides an effective barrier keeping the dye from the surrounding environment.
  • a multi-part chemical process for preparing an imaging sphere comprises the following steps: (1) an organic or inorganic material is deposited onto the surface of a bead to form a solid sphere; (2) the core of the bead is removed to create a hollow sphere; and (3) the hollow core is loaded with an imaging agent to form an imaging sphere.
  • the organic material deposited onto the surface of a bead comprises a protein (e.g., albumin), lipid, or polysaccharide and results in the formation of a "soft shell" around the core.
  • the inorganic material deposited onto the surface comprises silica or silica derivatives and results in the formation of a "hard shell.”
  • inorganic material deposited onto the surface of a bead comprises titanium or titanium derivatives, e.g., titanium dioxide, and results in the formation of a "hard shell.”
  • a hard shell is a silica shell.
  • the inorganic or organic material is doped with a suitable dopant to adjust the porosity, strength, or biodegradability of the shell.
  • the bead is a polymeric bead.
  • polymer beads are comprised of any suitable polymer.
  • suitable polymers include, but are not limited to, opolyacrylamine, poly(vinyl chloride), poly(vinyl chloride) carboxylated, polystyrene, polypropylene, poly (vinyl chloride-co-vinyl acetate co-vinyl) alcohols, latex, or any combination thereof.
  • the polymeric bead is commercially available.
  • the polymeric bead is synthesized prior to use.
  • the polymeric bead comprises materials such as polystyrene or latex.
  • the polymer bead comprises amine or carboxylated derivatives of a polymer.
  • polymer beads are commercially available in the desired size.
  • a polymer bead is synthesized to be a particular size.
  • Polymer beads for non-limiting example, polystyrene beads, are available commercially in a wide variety of sizes, including beads ranging in size from 45 to 500 nanometers.
  • the polymer beads are synthesized via emulsion polymerization, which allows for the creation of beads with a particular diameter.
  • the polymer core is removed by calcination or solvent extraction resulting in a hollow sphere. In some embodiments, removal of the core results in a uniform, stable silica shell. In some embodiments, removal of the core results in a shell surrounding a hollow cavity.
  • the shell and/or sphere is biocompatible and safe for use inside a human organism.
  • the shell and/or sphere is comprised of silica gel and the silica shell and/or silica sphere is biocompatible.
  • the hollow sphere is loaded with an imaging agent to form an imaging sphere (sometimes referred to as the "payload").
  • an imaging agent sometimes referred to as the "payload”
  • the terms “shell” and “hollow sphere” may be used interchangeably.
  • the hollow cavity of the sphere is loaded with any imaging agent described herein.
  • the hollow sphere is prepared prior to loading with an imaging agent.
  • the hollow sphere is subjected to a vacuum wherein the sphere is evacuated.
  • the hollow sphere is subjected to a vacuum of l0 "J torr.
  • a vapor comprising an imaging agent is injected into a vessel containing the sphere.
  • a vapor comprising an imaging agent is injected via a gas syringe into a vessel containing the sphere. In some embodiments, a vapor comprising an imaging agent is injected more than once into the vessel. In some embodiments, degassed water is added to the vessel containing the spheres following injection with the vapor.
  • hollow shells and/or loaded shells are produced by one of skill in the art upon reading the present description herein and one or more of U.S. Patent 8,440,229, U.S. Patent App. 20130230570 International Patent App. WO2014052911, and International Patent App. WO2009023697, incorporated herein by reference in their entirety.
  • any reference to sphere or nanosphere herein, whether hollow or not, may alternatively described using non-spherical shapes and nearly-spherical shapes such as, for non-limiting example: ellipsoids, ovoids, spheroids, hyperboloids, paraboloids, cones, cylinders, cubes, cuboids, columns, prisms, rectangular prisms, triangular prisms, hexagonal prisms, pentagonal prisms, octahedrons, dodecaedrons, icosahedrons, pyramids, tetrahedrons, square pyramids, hexagonal pyramids, or any partial three-dimensional version thereof.
  • a sphere is loaded with a metal particle or metal-containing particle.
  • the metal particle or metal-containing particle is incorporated into the sphere prior to the deposition of the silica or titanium.
  • an aqueous colloidal suspension of a metal oxide particle precursor or metal oxide nanoparticle precursor is added to a polystyrene composition prior to the deposition of silica or titanium.
  • a polymer bead is synthesized using a polymer that comprises a metal oxide particle precursor or metal oxide nanoparticle precursor.
  • the polymer core is removed while leaving the metallic particle inside the core of the sphere.
  • loaded spheres and/or loaded shells are produced by one of skill in the art upon reading the present description herein and one or more of U.S. Patent 8,440,229, U.S. Patent App. 20130230570 International Patent App. WO2014052911, and International Patent App. WO2009023697, incorporated herein by reference in their entirety.
  • the outer or inner surface of the shell is functionalized with an imaging agent.
  • the hollow core is additionally loaded with an imaging agent or the same imaging agent that is on the outer or inner surface of the shell.
  • the outer or inner surface of the shell is functionalized with a fluorophore molecule.
  • Surgical instruments are designed to perform either diagnostic or therapeutic operations to locate the cause of a problem, or to treat a problem once it has been found. Each of the tens of thousands of surgical instruments is designed to perform a specific function. Those functions are generally categorized under one of the following uses: to cut or incise; to retract; to grasp, hold or occlude; to dilate or probe; to cannulate or drain; to aspirate, inject, or infuse; to suture or ligate.
  • a surgical instrument used according to the methods and included in the devices and systems herein may include a surgical needle.
  • the surgical needle may be straight, 1/4 circle, 3/8 circle, 1/2 circle (subtypes of this needle shape include, from larger to smaller size, CT, CT- 1, CT-2 and CT-3), 5/8 circle, compound curve, half curved (also known as ski), and/or half curved at both ends of a straight segment (also known as canoe).
  • the surgical needle may have a particular point geometry, such as a taper geometry (needle body is round and tapers smoothly to a point), a cutting geometry (needle body is triangular and has a sharpened cutting edge on the inside curve), a reverse cutting geometry (cutting edge on the outside), a trocar point or tapercut geometry (needle body is round and tapered, but ends in a small triangular cutting point), a blunt point for sewing friable tissues, a side cutting or spatula point (flat on top and bottom with a cutting edge along the front to one side) for eye surgery.
  • the surgical needle may be an atraumatic needle that is permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied.
  • the device, system or method comprises a surgical instrument used to cut or incise, which are frequently referred to as "sharps," and include scissors, knives, scalpels, chisels and osteotomes, among others.
  • a surgical instrument used to cut or incise which are frequently referred to as "sharps," and include scissors, knives, scalpels, chisels and osteotomes, among others.
  • the device, system or method comprises a surgical instrument used to retract, and are frequently referred to as "retractors.”
  • Surgical instruments used to retract include hand-held and self -retaining retractors, as well as instruments such as skin and bone hooks.
  • the device, system or method comprises a surgical instrument used to grasp, hold or occlude, and are frequently referred to as "forceps.”
  • Forceps include hemostats, dressing and tissue forceps, bone holding forceps, and needle holders.
  • the device, system or method comprises a surgical instrument used to cannulate or drain, such as a catheter, drain, or cannula, for non-limiting example.
  • the device, system or method comprises a surgical instrument used to aspirate, inject or infuse, such as a syringe, a needle, a trocar and a cannula, for non- limiting example.
  • a surgical instrument used to aspirate, inject or infuse such as a syringe, a needle, a trocar and a cannula, for non- limiting example.
  • the device, system or method comprises a surgical instrument used to suture or ligate, such as a suture, clip, suture needle and a ligating instrument.
  • a surgical instrument used to suture or ligate such as a suture, clip, suture needle and a ligating instrument.
  • Surgical instruments include, but are not limited to, microsurgical instruments, sponges, towels, scissors, forceps, needle holders, needles, retractors, elevators, awls, bone hooks, bone curettes, osteotomes, chisels, gouges, mallets, tamps, bone files, rasps, bone cutters, trephines, bone rongeurs, bone saws, bone knives, spinal rongeurs, wire implants, pin implants, wire cutters, pin cutters, hand drills, bone screws, bone plates, drill bits, taps, depth gauges, drill sleeves, screwdrivers, bending templates, and plate blending instruments.
  • a surgical instrument comprises a particular joint type, handle type, retaining system, blade curvature type, blade type, or bone holding type.
  • a joint type is a box lock, lap joint or double-action joint.
  • the handle type is chosen from the following: ring handle, ring handle with one extra large handle, grooved handle, grooved handle with horn, or hollow handle.
  • a surgical instrument comprises a retaining system chosen from one of the following: ratchet lock, single spring, double spring, spring with roller, double spring with ball and socket joint, double leaf spring, cam ratchet, bar and wingnut, sliding ring, or bar ratchet.
  • a surgical instrument comprises a blade curvature chosen from one of the following: straight, curved on flat, curved on flat-slightly curved, curved on flat- strongly curved, curved on flat- s- shaped, laterally curved, laterally angled, angled on flat, bayonet-shaped, bayonet tip, blunt, blunt with bevel, sharp blunt, angled on flat, sharp, fine tip- sharp, fine tip-blunt, sharp with ball end, blunt with round probe end, blunt with retaining hook, blunt with probe end, blunt and angled on flat, blunt with spade probe end, blunt with triangular section, serrated dissector end, blunt with one hook end, fine straight jaw, round jaw, square jaw, straight or angled on flat, concave cutting jaw, end-cutting straight jaw, end-cutting concave jaw, punch upward, through cutting, punch upward oblique, and not through cutting.
  • a surgical instrument comprises a bone holding jaw.
  • the bone holding jaw is chosen from one of the following: bone holding, bone holding semb, bone holding farabeuf, and bone holding GmbHbeck.
  • a surgical instrument is manufactured from a variety of materials.
  • instruments are manufactured from stainless steel, tungsten carbide, aluminum, plastics, titanium, or a combination thereof.
  • a surgical instrument is manufactured from stainless steel, which is composed primarily of iron but further comprises one or more of the following elements: carbon; silicon; manganese; phosphorous; sulphur; and chromium.
  • a surgical instrument is manufactured from tungsten carbide, which is an alloy of tungsten and carbon. In some embodiments, a surgical instrument is manufactured from aluminum. In some embodiments, a surgical instrument is manufactured from aluminum which is anodized to form an oxide layer on the surface of the aluminum.
  • a surgical instrument is manufactured from a biocompatible material such as titanium. In some embodiments, a surgical instrument is manufactured from titanium where the light weight of the titanium prevents surgeon fatigue.
  • a tag comprising a polymeric matrix and one or more imaging spheres is applied to a surgical instrument as a coating.
  • a tag comprising one or more imaging spheres suspended in an adhesive polymer is applied to a surgical instrument as a coating.
  • a tag comprising one or more imaging spheres suspended in an adhesive polymer is applied to a discrete portion of a surgical instrument.
  • a tag comprising one or more imaging spheres suspended in an adhesive polymer is applied to a surgical instrument, wherein the tag is a small shape, e.g., dot, square, stripe.
  • a tag comprising one or more imaging spheres suspended in an epoxy is applied to a surgical instrument, for non-limiting example, a needle.
  • a tag comprising a mixture of a polymer and one or more imaging spheres is applied to a surgical instrument.
  • a tag comprising a mixture of an adhesive polymer and one or more imaging spheres is applied to a surgical instrument, e.g., needle.
  • a tag comprising a mixture of an epoxy and one or more imaging spheres is applied to a surgical instrument, for non-limiting example, a needle.
  • a tag comprising one or more imaging spheres suspended in a polymeric matrix and adhered to the surface of a support medium is applied to a surgical instrument.
  • a tag comprising one or more imaging spheres suspended in a polymeric matrix and adhered to the surface of a support medium is applied to a surgical instrument via an adhesive polymer on the support medium.
  • a tag comprising one or more imaging spheres suspended in an adhesive polymer and adhered to the surface of a support medium is applied to a surgical instrument.
  • a tag comprising one or more imaging spheres suspended in an epoxy and adhered to the surface of a support medium is applied to a surgical instrument.
  • a separate coating is applied to a tagged surgical instrument to prevent degradation of the tag during sterilization.
  • a tag comprising one or more imaging spheres suspended in a polymeric matrix is embedded in a surgical instrument.
  • a tag comprising one or more imaging spheres suspended in a polymeric matrix is embedded into a thread bundle of a needle.
  • a tag comprising one or more imaging spheres suspended in an adhesive polymer is embedded in a surgical instrument.
  • a tag comprising one or more imaging spheres suspended in an epoxy is embedded in a surgical instrument.
  • a tag comprising imaging spheres suspended in an adhesive polymer is embedded into a thread bundle of a needle.
  • a tag comprising imaging spheres suspended in epoxy is embedded into a thread filament or thread bundle or thread in a surgical instrument, e.g., needle.
  • Example 1 Tagging a surgical needle
  • Figure 1 illustrates a tagged needle.
  • Figure 1A depicts an embodiment including a surgical instrument comprising a surgical needle 110, a surgical thread 120, and a tag 130 comprising an imaging sphere suspended in an adhesive polymer placed at the joint area of the surgical needle and surgical thread.
  • Figure IB depicts a magnified view of the joint area of the surgical instrument embodiment of Figure 1 A.
  • a tag is prepared as follows. A commercially available 2.0 micron polystyrene bead is used. The polystyrene bead is coated with a polyamine to facilitate a sol gel reaction. The bead is mixed with tetramethylorthosilicate for 2 hours, followed by addition of trimethoxyboron.
  • the resulting particles are washed with water and ethanol to remove unreacted starting materials.
  • the polystyrene bead core is subsequently removed via calcination at 550 °C for 18 hours. This yields a hollow porous silica gel particle with uniform wall thickness of approximately 10 nm.
  • the hollow silica particles are then loaded with perfluoropentane by injecting PFP vapors using a gas syringe into a vessel containing the hollow silica particles. The injection of PFP vapors is performed 4 times.
  • the resultant gas-filled silica spheres are sonicated to create a uniform suspension.
  • the silica spheres are then mixed with cyanoacrylate to form an adhesive polymer with imaging properties.
  • the resultant adhesive polymer is coated onto a thread filament in the joint area between the surgical needle and the surgical thread. Additionally or alternatively, the resultant adhesive polymer is used to adhere the thread filament to the surgical needle.

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Abstract

La présente invention concerne un marqueur comprenant une sphère d'imagerie suspendue à l'intérieur d'une matrice. Dans certains modes de réalisation, la matrice comprend un polymère. Dans certains modes de réalisation, la matrice comprend un polymère adhésif. Dans certains modes de réalisation, la matrice comprend un polymère à longue durée de conservation. Dans certains modes de réalisation, la matrice comprend un époxy. Dans certains modes de réalisation, le polymère adhésif comprend du cyanoacrylate. Dans certains modes de réalisation, la sphère d'imagerie comprend une cavité chargée avec un agent d'imagerie entouré par une écorce. Dans certains modes de réalisation, l'agent d'imagerie présente des propriétés échogènes. L'invention concerne en outre un procédé de préparation d'une sphère d'imagerie consistant à : déposer une matière organique ou inorganique sur une surface de bille de sorte à former une sphère présentant un cœur solide ; éliminer le cœur solide par extraction par solvant ou par calcination de sorte à former une sphère creuse ; et charger la sphère creuse avec un agent d'imagerie.
PCT/US2015/025376 2014-04-11 2015-04-10 Instruments chirurgicaux marqués et procédés associés WO2015157676A1 (fr)

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CN201580016060.5A CN106604751A (zh) 2014-04-11 2015-04-10 带标记的手术器械及其制造方法
EP15776698.1A EP3129077A4 (fr) 2014-04-11 2015-04-10 Instruments chirurgicaux marqués et procédés associés
AU2015243218A AU2015243218B2 (en) 2014-04-11 2015-04-10 Tagged surgical instruments and methods therefor
US15/303,286 US20170027660A1 (en) 2014-04-11 2015-10-04 Tagged surgical instruments and methods therefor

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EP3129077A4 (fr) 2017-11-22
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